Ohio GOP struggles with whether to allow vote on Medicaid expansion

Sep. 27, 2013

Gov. John Kasich speaks about health coverage July 9 in the Ohio Statehouse in Columbus. Ohio lawmakers will return to the Statehouse next month faced with the decision of whether to expand Medicaid. / Chris Russell/The Columbus Dispatch, AP

: A Democratic bill for Medicaid expansion that includes some reforms.

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Despite pressure from Ohio’s Republican governor and state Democrats, the expansion of Medicaid for poorer Ohioans remains stuck in the morass of state legislative politics.

Six bills have been introduced to deal with Medicaid, and experts agree expansion and reform of the health care program likely will dominate the Ohio Legislature when the body returns to full action this week. But while the debate almost assuredly will happen, the result remains ambiguous.

The uncertainty is so great that a group is pushing for expansion using a November 2014 ballot measure; others have examined expanding Medicaid through a workaround by a handful of legislators.

“This is one of most difficult issues I’ve seen in how to peg how it will turn out,” said Greg Lawson, of the conservative Buckeye Institute.

Gov. John Kasich proposed expanding Medicaid to hundreds of thousands of Ohioans who make less than 138 percent of the federal poverty line, as was intended under President Barack Obama’s health care reform law. A Supreme Court decision left it to the states to decide whether to expand the health care program.

At the heart of the debate in Ohio is a divided Republican House, where some have said the 60 members are split into thirds: 20 lean toward supporting expansion, 20 are unsure about expansion and 20 vehemently oppose it. But simply passing the expansion by relying mostly on Democratic support would infuriate hard-liners who see the Medicaid expansion, and its ties to Obamacare, as a line in the sand for conservatives, Lawson said.

“That would blow the caucus apart,” he said.

But Rep. Chris Redfern, D-Catawba Island, said the talk about politics is nonsense when it comes to providing health care for Ohioans in need. Instead, a governor who supports it — and is a rumored 2016 presidential candidate — should be able to cajole his caucus to support the expansion.

“It’s a question of political will,” he said.

Rob Nichols, spokesman for Kasich, said it is “not credible” to say the governor hasn’t been lobbying legislators to support expansion. He said representatives have said they are committed to working on the issue and the governor has no reason to doubt their sincerity.

“We are giving them the opportunity to come through on that,” he said.

Kasich wants the Legislature to take the federal government up on its offer to pay to expand Medicaid to up to 366,000 new Ohioans. The federal government would pay 100 percent of the cost of expansion from 2014 through 2016. After that, the federal funding would start to scale back until it reached 90 percent in 2020.

Rep. Gerald Stebelton, R-Lancaster, said his vote depends on whether the federal government will allow Ohio to opt out if the reimbursement drops below 90 percent. Under the current system, “once you’re in, you’re in,” he said.

“That’s going to be the litmus test,” he said.

Stebelton said Rep. Barb Sears, R-Monclova Township, and finance committee chairman Ron Amstutz, R-Wooster, were making some progress in that area, but he didn’t know the specifics.

Finding reforms

In addition to seeking expansion of Medicaid, the Legislature also is looking at how to reform the system to curb its costs and growth.

Sen. Dave Burke, R-Marysville, has been one of the leaders in that effort, participating in hearings across the state on the issue. He said he thinks there are ways to reform the system, which he said is needed for a program that now accounts for nearly 40 percent of the state budget.

“If we are going to do something like that (expansion), it has to be affordable,” he said. Before that can happen, Burke said the state needs to have a “mature talk” about what the program should include.

State Sen. Troy Balderson, R-Zanesville, said expanding Medicaid and reforming it are two different things.

“Let’s fix what we have first,” he said. “We don’t want to dump more money into something that’s broken.”

He said Medicaid expansion, as Gov. John Kasich has outlined it, would not pass an up-or-down vote in the Senate.

Lawson said his group is working on an alternative proposal to Medicaid expansion, one that would be entirely run by the state and that would include work requirements for recipients to get benefits. Such requirements are not allowed in the federal program.

The governor recently placed work requirements on food stamp recipients in most Ohio counties, and Lawson said similar rules are needed for Medicaid. He said the move would help force people to enter the workforce, where eventually they could earn enough to buy their own insurance from the health care exchanges.

“The goal here is to get people working and be self-sufficient,” he said. “Medicaid expansion does not do that.”

However, Redfern said the idea that people choose to be on Medicaid instead of working is based in “ignorance.”

“It is an antiquated notion that poor people wish to stay poor,” he said.

Bypassing lawmakers

Because expansion has stalled in the Legislature, supporters of the effort have begun looking at alternative means to their end. One possibility is using the state controlling board, which has the authority to handle appropriations for some financial matters for the state. Supporters argue that because the federal government is initially fully financing the expansion, the board would have the authority to approve accepting this federal money.

Lawson said while he wouldn’t be surprised to see an effort made at the seven-member board, he isn’t sure it will be successful. For one, he isn’t sure there would be a majority of the board to support expansion — two of the board members are Democratic legislators, one is appointed by the governor and the remaining four are Republican legislators.

In addition, he said there is a legal question of whether the board can approve expansion, especially after the Legislature voted to prohibit expansion — a move Kasich vetoed.

Redfern, a board member, said trying to use the controlling board likely would cause more problems and delays than a simple vote in the House.

“I’m not sure we want to waste time with lawsuits and litigation,” he said. “That’s what my tea party friends will do if this goes through the controlling board.”

Supporters also are pushing for a ballot initiative to expand Medicaid. While the group has had success gathering signatures so far, the issue still wouldn’t come before voters until November 2014 if the Legislature fails to act.

Wendy Patton, a policy analyst for the progressive Policy Matters Ohio, said the state is already facing a time crunch to expand Medicaid in time for people to take advantage in January. Waiting for a referendum would force poorer Ohioans to wait another year before getting help, but she said it would be better than nothing.

“If the ballot’s the way we’ve got to go, then it’s the way we’ve got to go,” she said.

Other legislation

While Medicaid expansion is expected to be the dominant issue, the Ohio Legislature also is expected to tackle several other topics. Here is a look at some of them.

Municipal income tax reform

• Summary: The massive overhaul bill would make Ohio’s numerous municipalities follow more standardized practices in how they collect income taxes, although it would not affect rates. Supporters say this would eliminate large costs for businesses to file often complicated and duplicative tax filings for their employees. City officials argue the bill would reduce their local control and cost them needed revenue.

• Status: Despite being introduced in January, the bill remains in the House Ways and Means committee and has not received a vote as the two sides try to find some compromise.

Heartbeat bill

• Summary: The bill would ban abortion after a fetal heartbeat is detected. The bill, sponsored by Rep. Christina Hagan, R-Alliance, and Lynn Wachtmann, R-Napoleon, would prohibit abortion as early as six weeks and create a legislative committee to promote adoption.

• Status: The proposed legislation was introduced Aug. 21 and has not been assigned to a committee. Forty Republican members already have signed onto the bill. A similar bill passed the House of Representatives last year, but did not get a Senate vote by the end of the session. Heartbeat laws that passed in Arkansas and North Dakota have been temporarily blocked by federal court judges. Texas Gov. Rick Perry signed a law banning abortions after 20 weeks this summer; legislators subsequently introduced a bill to ban abortions after six weeks.

Stand your ground

• Summary: The proposal, introduced in June by Rep. Terry Johnson, R-McDermott, would remove the need to retreat when claiming self-defense. Ohio law does not require victims to retreat from their home, vehicle or relative’s vehicle. The bill also would simplify carrying concealed weapons across state lines, add another background check to the process of applying for a concealed-carry license and streamline which criminal offenses disqualify individuals from obtaining a license.

• Status: The proposed legislation was assigned to the Policy and Legislative Oversight committee, but has not had a vote. Sixteen Republicans have signed onto the proposal.

Internet cafes

• Summary: The proposal is an effort to eliminate Internet cafes even as backers attempt to put the issue before voters in November 2014. It would bar sweepstakes games that award prizes in excess of 5 percent of the business’ gross annual revenue. Violating that threshold would result in criminal charges, according to the proposed legislation.

• Status: The bill passed the Senate with a 25-7 vote in June and was assigned to the House’s Policy and Legislative Oversight committee, which has not held a vote on it. Internet cafe proponents also are working to eliminate a similar law, which passed in June and would bar cash or prizes valued at more than $10, by asking voters to repeal it. They have until Thursday to collect 231,000 valid signatures and prevent the law from taking effect in the interim.

Welfare drug testing

• Summary: The bill, sponsored by Sen. Tim Schaffer, R-Lancaster, would create a three-county pilot program that requires drug testing for welfare recipients who fail an initial screening. Schaffer said the screening, which is being developed by social service workers, will eliminate any Fourth Amendment legal concerns and mirrors a policy enacted in Missouri.

• Status: Previous efforts by Schaffer on this topic have failed, but he thinks the changes made make it more practical. It has five Republican cosponsors, but has not been assigned to a committee.

Energy efficiency mandates

• Summary: In 2008, the Ohio Legislature unanimously passed an energy bill that, among other things, required the state’s utilities to generate 12.5 percent of their electricity from renewable sources. SB 58, reintroduced Wednesday, would kill a provision that required half of that renewable requirement to come from sources inside the state. Supporters say the bill is a common-sense response to economic changes that surfaced once the national recession took hold later in 2008. Opponents of the repeal effort say energy efficiency saves consumers money and support a nascent alternative energy industry that employs 25,000 people in the state.

• Status: The bill had its first hearing Wednesday afternoon, and it was contentious, said Troy Balderson, R-Zanesville, a member of the Senate Public Utilities Committee. “If (Wednesday was) any indication, it’s going to be a little while (before a vote),” he said.

Jessie Balmert and Russ Zimmer of CentralOhio.com contributed to this report.